[Surgery]  Narrow ridge for 22 implant

Hi guys,


I have a 22 implant but CT shows that ridge narrowing to 2.46mm at the apex but widens again beyond that point.  Patient has low lip rise.  Defect appears to be on the palatal.  Should I graft on buccal anyways and place the 3.5 Hiossen mini or graft and wait.  Is it even possible given that the original 22 was rotated and the space left in the arch is only 4.8mm?





by Sokhi Sandhu at Wed, Jul 16, 2014 3:28 PM

1312 Views | 5 Replies

Attached Images


Likes : 0

Bernard Jin Replied at Thu, Jul 17, 2014 8:01 PM

Well said guys! Agreed!

Likes : 0

Mark Kwon Replied at Thu, Jul 17, 2014 6:31 PM

This is a tricky case. Wax-up is needed.

Likes : 0

Glenn van As Replied at Thu, Jul 17, 2014 1:11 PM

Hi there Sokhi...Jim and Ho-Young gave you EXCELLENT answers to your question. It is tough from a single slice to give you a concrete solution. Many times in a case like this photos,2d xrays and even models tell us more about occlusion, smile line, shape of adjacent teeth etc. Having said this i agree with Jim that 0.9 mm is too close and you might hit an adjacent root so even the 2.8 mm B-L dimension is not the issue. I will say that for laterals one piece 3.0 mm Minis or even a 2.5 mm ( if you want to push it) can give you more space....a 3.0 mm will leave you with 1.4 mm on each side..... SO keep that in mind after you graft the buccal of this case...Ideally the roots are divergent for the central and lateral but again with one slice its impossible to tell exactly how to treat this case. It begs for a "van As" treatment plan setup to give you a comprehensive approach. Thanks Glenn

Likes : 0

Ho-Young Chung Replied at Thu, Jul 17, 2014 5:41 AM

Hi Sokhi, very interesting case indeed. I think Jim has said given you very good feedback. how about doing a bit of ortho to increase M-D spacing? Why did this patient lose this tooth to begin with? How's the patient's occlusion? I agree with Jim. yes, grafting prior to placing is a wise choice. MD spacing for the crown and the implant is very limited. Ho-Young

Likes : 0

Jim Yeganegi Replied at Wed, Jul 16, 2014 4:57 PM

Sokhi thank you for sharing this with us. Some things to consider: -if you only have 4.8mm of space between the proximal teeth, even if you use a 3mm implant (mini) this gives you (4.8-3=1.8mm of total space left and if you /2=.9mm of space on either side of your implant if you were bang center with your osteotomy. You want to give yourself 1.5mm of bone between tooth and implant to be safe. So spacing seems to be a bit of an issue . -if you attempt to do an osteotomy and graft at same time you will likely either perforate out the buccal /palatal or worse, fracture the bone at that weakend narrow point near the apex. So best to graft first and let it heal then go back and place your implant. -what's your crestal bone width dimension? -have you looked at the slices of the adjacent teeth ? it's a strange spot to get a defect or narrowing like that. Just wondering if there's not a lesion creeping in from an adjacent tooth, cyst, etc. -can you send us some more images of the adjacent teeth and perhaps a pano view as well so we can see the root anatomy and direction of the adjacent teeth? it'll help in diagnosing and tx planning. thanks again for sharing this interesting case with us. Lots for us to learn from. Jim